BY MAHALETCHUMY ARUJANAN & SAARANI VENGADESEN
IF THERE is one cancer that can be eliminated completely from the face of the earth, it is cervical cancer. Imagine if 604,237 women globally could have been spared the painful experience of contracting this cancer and 341,843 lives saved.
What is probably more painful than the cancer is the stigma attached to it – that promiscuity is a cause of the cancer that leaves many women not wanting to seek treatment. The fact is, even women with single sexual partners could contract cervical cancer as everyone, men and women, live with this Human Papillomavirus (HPV) that causes the disease.
Many people who contract HPV exhibit no symptoms as they are capable of quickly clearing the virus from their bodies. There are also low-risk HPVs that cause genital warts. The notorious strains 16 and 18 are the ones that are responsible for 70% of cervical cancer cases, and another dozen other high-risk HPV strains that collectively account for the other 30% of cervical cancers.
What is needed to make cervical cancer a thing of the past is proper screening, besides vaccination against the HPV that causes the cancer. The HPV vaccine was first made available in 2006 and as of 2017, 71 countries include it in their routine vaccinations.
In Malaysia, the National HPV Immunisation Programme was introduced in 2010, targeting 13-year-olds girls. The success of this programme will be seen a few decades from now.
For the screening, women have been relying on pap smear that is based on probability and chances. It gives false assurance as cancer cells could be missed when collecting cells from the cervix, or when sampling from the tube where the cells are stored.
Prof Dr Woo Yin Ling, a consultant gynaecology oncologist at University Malaya Medical Centre (UMMC) is excited to introduce a new tool to eliminate cervical cancer. The test Woo is trying to get every Malaysian woman to do is called the HPV DNA test.
“Unlike pap smear, the HPV test does not detect cancer cells, instead it identifies the virus itself, which means we can arrest the cancer before even it starts to manifest,” says Woo who started an NGO called Program ROSE.
Program ROSE stands for Removing Obstacles for Cervical Screening. It is aptly named, as women, including the educated ones shy away from pap smears due to the intrusion method which transgresses women’s private space.
“The HPV DNA test is partly a self-test as women can collect their own sample using a swab, that looks like a cotton bud, only much longer. It takes no time to collect the sample. All we need to do is insert the swab into the vagina, twirl it ten times. What sticks to the swab is enough to detect the presence of the virus,” Woo explains.
Unlike pap smear that needs to be done annually, HPV DNA test is only done once over a 5-10 year period.
Woo says that two screenings in a lifetime are enough, adding that in 2018, the World Health Organization (WHO) announced that the primary screening method for cervical cancer is no longer the pap smear test but the HPV DNA test which has been in use since 2013.
In 2019, Malaysia introduced the HPV DNA test as the primary screening method but the public is still unaware about it as the Covid-19 pandemic hit in 2020.
The HPV DNA test is more accurate than the pap smear because it uses the Polymerase Chain Reaction (PCR) method. PCR is no more a fancy buzzword for us as it has been bandied about since the Covid-19 pandemic.
The public is well informed that PCR is a highly accurate way to diagnose genetic changes by finding the DNA or RNA of a “disease-causing organism” such as the HPV virus. There are 200 types of HPV and the ROSE Program HPV test is able to detect 14 types of HPV.
Debunking myths of cervical cancer has to take place as women assume that they have cervical cancer when their HPV DNA test shows a positive result. Being “positive” does not mean it is cervical cancer but it could be just an early indication that there is a potential risk of cancer development which could be treated with clinical intervention.
“Smoking or exposure to cigarette smoke can increase the risk of persistent HPV infection and therefore causes a higher risk of cervical cancer. It is just the matter of health literacy and the stereotypes have to be broken”, said Woo.
Program ROSE uses a secure digital e-health platform that allows women to have all their follow-up communication through their phone privately with the health experts.
Recently, an event to support this initiative was organised by a group of prominent women in the country which also included social media influencers. The cervical screening was held at Tiarasa Luxe, hosted by Tiara Jacquelina, Among the others who were part of the event were Prof Dato’ Dr Adeeba Kamarulzaman, Tan Sri Jemilah Mahmood, Melisa Melina Idris, Dr Jezamine Lim, and Surina Shukri.